Fractures of the medial humeral epicondyle
Objectives- Describe mechanism of injury for fractures of the medial humeral epicondyle
- Discuss the clinical and radiographic findings of fractures of the medial epicondyle
- Discuss the management of fractures of the medial humeral epicondyle
Discussion point
- After a literature review on this subject, how do you decide what to do for this injury?
Discussion
Medial epicondyle fractures tend to occur in older children than supracondylar or lateral condyle fractures, often from athletic activities, arm wrestling being a particularly oftmentioned activity. Injuring forces that would result in a humeral shaft fracture in an adult may fracture the medial epicondyle when the apophysis is not yet closed. A large number of medial epicondyle fractures accompany elbow dislocation; the medial epicondyle fracture may be the only radiographically evident injury if the dislocation spontaneously reduces.
Everyone writing on the subject agrees that minimally displaced fractures may be treated with immobilization. For displaced fractures, the literature is obfuscating. If there is any trend, it would be toward internal fixation for those who may want to return to sports activities; for others it is still quite unsettled. The study by Joseffson is a standard for the quite good results of nonoperative management. Even with medial epicondylar fractures accompanying elbow dislocation, symptomatic instability was uncommon.
References
- Case SL, Hennrikus WL. Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. American Journal of Sports Medicine 1997; 25( 5): 682-6.
- Dias JJ, Johnson GV, Hoskinson J, Sulaiman K. Management of severely displaced medial epicondyle fractures. Journal of Orthopaedic Trauma 1987; 1( 1): 59-62.
- Hines RF, Herndon WA, Evans JP. Operative treatment of Medial epicondyle fractures in children. Clinical Orthopaedics & Related Research 1987( 223): 170-4.
- Josefsson PO, Danielsson LG. Epicondylar fractures in children: 35-year follow-up of 56 unreduced cases. Acta Orthop Scand 1986; 57: 313-15.
- Moon MS, Kim I, Han IH, Suh KH, Hwang JD. Arm wrestler's injury: report of seven cases. Clinical Orthopaedics & Related Research 1980( 147): 219-21.
- Pimpalnerkar AL, Balasubramaniam G, Young SK, Read L. Type four fracture of the medial epicondyle: a true indication for surgical intervention. Injury 1998; 29( 10): 751-6.
- Skaggs DL. Elbow fractures in children. Diagnosis and management. J Am Acad Orthop Surg 1997; 5: 303-12.
- Wilson NI, Ingram R, Rymaszewski L, Miller JH. Treatment of fractures of the medial epicondyle of the humerus. Injury 1988; 19: 342-44.
May 16-19, 2012 in Denver, CO
